You will need to sign on with your LLLID (La Leche League ID) before you can post. If you have never claimed your LLLID, create your LLLID now. To sign in, click the LLLID Sign On button in the upper right corner. Enter your LLLID Alias and click the button again.

Weaker suck post frenotomy - normal?

My son had a lip and posterior tongue tie clipped a week ago. He is 7 weeks old. We have been dealing with low milk supply from the start mainly because he was not transferring milk well and working so hard made him sleepy. His suck was super strong and when the muscles got tired he would resort to gumming the milk out and then fall asleep.
Since the clip I have had less pain but his suck has been getting weaker as the days go on. I have to latch him on many times before he "sticks", he loses suction and pops off all the time, and he is not sucking with long draws like I remember with my other babies. It seems more like comfort sucking. Again he has a tendency to fall asleep quickly. The dentist who clipped him mentioned that the suck shouldn't be so strong and when he sucks the muscles up by the temples (?) don't move, so he has relied on other muscles til now. I am trying exercises with a finger and he is just all over the place, sucking, chewing, no suction. I know it has only been a week and it will take some time for him to figure it out; I am looking for supportive words from other moms who have been here! Yesterday I came down with my first case of mastitis and I know it has to be that he isn't moving the milk.

Re: Weaker suck post frenotomy - normal?

I just got my son treated for lip and tongue tie today. The instructions from the dentist included a comment that he will need to re-learn how to suck and made it plain that I will probably need to work with a lactation consultant a few days after the procedure.

Today after the procedure and again when I got home, his suck and chomp seem more gentle to me but I'm figuring that was because he was hurting. Definitely after the procedure he was moving his tongue about a whole lot like he was experimenting with the increased range of motion. (his was a posterior tongue tie and his upper lip had a thick tie though the length of his upper lip meant that even before the procedure he had been able to manage a seal so he could suck.)

Re: Weaker suck post frenotomy - normal?

venerye, can you see an IBCLC to have suck assessed and to get assistance helping baby learn to suck?

Are you concerned baby is not getting enough to eat? Is baby exclusively breastfed? Is it possible baby is simply getting more milk more easily than before and does not need to suck as hard or nurse as long?

This briefly discusses weak suck after frenectomy, but it is mostly about how to use a lactation aid to help correct the issue. Are you supplementing? using a lactation aid? http://cwgenna.com/postfren.html

Re: Weaker suck post frenotomy - normal?

The nearest IBCLC is 45 minutes away and unfortunately we only have one vehicle right now. It will be possible to get out there once we replace the car that died...

I've been concerned about baby not getting enough to eat since the early days. He is not exclusively breastfed. He has been supplemented with formula and expressed bm since 2 weeks when he was not even close to birthweight. I can't tell you how many times I thought he was doing fine and the scale tells another story, so I don't really trust myself to know he's getting enough. We have never used a bottle or nipple of any kind, only syringe/finger feeding and now we exclusively use the lact-aid. He used to suck on our fingers so hard that it was difficult for us to tolerate a feeding! I'm not sure what exactly happened this week but my guess is that he was sucking somewhat better in the first days after tt release which stimulated my supply. Honestly he looked happier and more satisfied to me (but remember I don't trust myself). Then he failed to drain the breast later in the week which brought on the mastitis. I remember waking up in the middle of the night with engorged feelings and leaking. I have a hospital grade pump but I only use it a few times a day because he is always at the breast, and he doesn't sleep on his own well. In general if he's not sucking he's taking short naps in my arms. We cosleep, he wakes, I feed from a full breast and he'll nod off before it's empty, but if I lay him down to go pump the rest out he'll wake up and cry. So I was asking for a plug by doing it this way, but sleep deprivation makes people do crazy things. Anyway, he is getting supplement from the lact-aid, but I still have to adjust or reinsert the tube a few times during the feed because it falls out or the milk isn't being drawn through (this was also happening before tt release though). He sometimes breaks suction with the lactaid with a loud "smack" and latches right back on.

The mastitis is on the producing side and I know he's not getting much. Today he was very hungry and unhappy so I gave him 2 extra oz of supplement late, after he had all day to suck my nipples off and stimulate supply. Normally I would be in a lot of pain now but the tt release helped with that at least... very little soreness. I searched for a bunch of tongue exercises and we are starting to try them out, and baby seems to like them so I am hopeful that they will help. We have a weight check tomorrow...

Re: Weaker suck post frenotomy - sad, mad!!

Long rant coming...

He had his weight check - 5 grams/day for the past week. Last week it was 17 grams/day and they approved me to drop another oz of supplement, which was a surprise but I was happy to try it. I think it is down now because I dropped the ounce and three days of mastitis lowered my supply a lot. But he still had 8-11 wets and 1-2 large bowel movements/day this week. My pumping output is still much lower on that side.

The ped is threatening hospitalization or even a call to CPS if he doesn't gain weight by Tues, next weight check. He said we're lucky he just doesn't diagnose the baby failure to thrive today, because he could. We are shocked. We have a very specific protocol to follow, just like at 2 weeks when he had to rapid gain birth weight. They calculate he is required to have 16 oz of breast milk at 19 calories and 10 oz of 24 calorie formula per day to get to 544 calories per day. There is no flexibility on this (basically "if it's too much he'll spit it up", "if he doesn't want it that's your problem"). I don't know how much breast milk I am producing. I have no scale here to do before and after weight checks and cannot rent such a scale.

We started this afternoon. He's had about 15 oz so far that I can track. His feeding from the lactaid is slow, and when he is not swallowing he is sleeping. I am constantly waking him. I feel so much that he is being overfed just like at 2 weeks. Here we are at 3 AM and the poor kid just wants to sleep, and I want to sleep to get over this infection I hate to introduce a bottle now, when he is relearning how to suck and my supply is on the edge and I need his help nursing this lump away, but we bought some in case it comes to that! I only need to make it until Tuesday and pass his weight check, then maybe the ped will back off!!! Thanks for listening to me vent!!!

Re: Weaker suck post frenotomy - normal?

Ok, you are in a very serious situation. A pediatrician threatening to call CPS should be taken very seriously. What would it take to see the IBCLC NOW rather than later? What about getting a second opinion from another pediatrician? I would also alert the dentist who did the clip. You need people in your corner who know the situation and are aware you are not neglecting your child.

If baby cannot be adequately nourished via breastfeeding or the sns, then you can bottle or cup feed. It does not mean that breastfeeding is over. If you have a pump and can pump, you can keep your production up while you figure out what is going on. With a bottle, Use paced bottle feeding (unless this also causes baby to not take in enough.) The website (CWG) I linked above has an article about using lactation aids that might be helpful. Jack Newman has a good video about cup feeding. I have linked in other threads info on paced bottle feeding. Sorry I am not able to link things now.

As far as the calorie counting and the ounce per ounce protocol, I cannot speak to that as you are under doctors orders. But if you are supplementing that much formula, it is very very important that you pump as frequently as you can with a very good pump. Hospital grade if possible. And yes, you need your rest. If you have any family or friends around who can help, it is time to call in favors.

Re: Weaker suck post frenotomy - normal?

We fed him exactly what was ordered and he gained a pound in four days. The doctor says it is an appropriate amount of weight and he is back on track, and he wants us to continue the same regimen minus 10% of the formula til next week. Same high calorie preemie formula. I couldn't believe it, but I was afraid to say no. They tried to spin it by saying that his average gain since mid April is around 35g/day, which is on target. I don't feel it is good when he "caught up" at the rate of 120g/day. I don't want my baby to keep gaining like this! It would be unhealthy for an adult to gain a pound in 4 days! We feel we have been forcing him to eat and this is harmful!! He has not been acting like himself... so lethargic.

The immediate threat is gone, at least.

My milk supply is gradually improving with the pump and the right side is recovering, but I am scared to death that all of the bottle feeds we had to do have confused his latch and suck -- again. It was a race against the clock to get all the supplement in him and sometimes only a bottle would do it. All of this makes me so sad

Re: Weaker suck post frenotomy - normal?

I agree a pound in four days seems extreme. Good gain in the first three months is considered an average of one ounce a day, or 7 or 8 ounces per week. So a pound in four days represents quadruple that. Some breastfed babies do gain more rapidly than an ounce per day and it is perfectly healthy, but of course some babies gain more slowly than that and it is perfectly healthy as well. (after ~three months gain rate normally slows)

How much your baby needs to be gaining to "catch up" or if "catching up" is even indicated or necessary is beyond my expertise.

I don't have much to add except to again urge you to seek a second medical opinion. Feeling as if you are forcefeeding your child sounds as if you are unhappy with the advice you are being given. Adequate supplementation when needed need not interfere with breastfeeding if precautions in feeding and pumping are taken as I mentioned in previous post. But over supplementation is much more problematic for continued breastfeeding.

Last edited by @llli*lllmeg; May 14th, 2014 at 08:00 AM.
Reason: Clarified some things